Active Rash, ILD, and Elevated NLR Independently Predict In-Hospital Mortality in Dermatomyositis: JAMA
USA: Researchers have found in a new study that active rash, interstitial lung disease (ILD), and elevated neutrophil-to-lymphocyte ratio (NLR) were independently linked to higher in-hospital mortality in patients with dermatomyositis, irrespective of subtype or antibody status. Identification of these risk factors can help optimize inpatient care and inform future risk assessment.
The study, published in JAMA Dermatology, was conducted by Dr. Anjana Srikumar from the Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, and her team. Dermatomyositis (DM) is an inflammatory disorder characterized by skin manifestations and muscle weakness, and it is known to carry a significant risk of hospitalization and death. However, factors contributing to in-hospital mortality have remained poorly understood until now.
To bridge this gap, the researchers carried out a cohort study including 153 adult patients diagnosed with dermatomyositis who were admitted to a tertiary care hospital between January 2013 and May 2024. All participants had their diagnosis confirmed by a dermatologist or rheumatologist, and data were analyzed between August 2024 and August 2025.
The team assessed various clinical and laboratory features present at the time of admission, including active rash, interstitial lung disease, muscle involvement, NLR, autoantibody status, and prior treatment regimens. The primary outcome was in-hospital mortality, and statistical analyses were adjusted for demographic factors and disease subtypes.
The key findings of the study were as follows:
- 10.5% died during hospitalization.
- The mean age of the study group was 56.5 years.
- Females made up nearly three-fourths of the cohort.
- Non-survivors were more likely to have an active rash (81.3% vs 34.3% among survivors).
- Interstitial lung disease (ILD) was more common in deceased patients (87.5% vs 41.6%).
- Mean neutrophil-to-lymphocyte ratio (NLR) was higher in non-survivors (12.5 vs 4.9).
- The prevalence of myositis did not differ significantly between survivors and non-survivors.
- Multivariable analysis identified active rash, ILD, and elevated NLR as independent predictors of in-hospital mortality.
- Active rash was linked to a 12-fold higher likelihood of death.
- ILD was associated with a sixfold increased mortality risk.
- Each one-unit increase in NLR raised the mortality risk by approximately 30%.
- Baseline use of intravenous immunoglobulin showed no significant association with survival after statistical adjustment.
Dr. Srikumar and colleagues emphasized that recognizing these high-risk features at admission could support timely clinical interventions and improved inpatient monitoring. The findings also highlight the potential of simple and readily available parameters, like NLR, in aiding risk stratification.
The authors acknowledged that the study’s retrospective, single-center design and small sample size may limit the generalizability of results. They also noted the absence of standardized disease activity measures and social determinant data. Nonetheless, they emphasized the importance of validating these findings in larger, more diverse populations to enhance their clinical utility.
"The study highlights that active rash, interstitial lung disease, and an elevated neutrophil-to-lymphocyte ratio are independent markers of poor prognosis in hospitalized dermatomyositis patients. Early recognition of these factors could guide better inpatient management and shape future strategies for risk assessment and treatment optimization," the authors concluded.
Reference:
Srikumar A, Kaltchenko M, Niknejad K, Bao A, McCaffrey T, Kang J. Active Rash, Interstitial Lung Disease, and Neutrophil to Lymphocyte Ratio and Mortality in Dermatomyositis. JAMA Dermatol. Published online October 29, 2025. doi:10.1001/jamadermatol.2025.4161
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